Case of the Month March 2015

Submitted by Garrett Dejesus, MD, and Thomas J. Learch, MD.

Mrs. J. H.

History of present illness:

68-year-old female presenting to the emergency room with severe lower abdominal pain, nausea and vomiting.  The patient reports a remote history of abdominal surgery for vague abdominal, discomfort.  The surgery found no cause for her pain.  She now reports acutely worsened abdominal pain.

Family history:

Ulcerative colitis (mother)

Physical examination:  

Vital signs within normal limits
Moderately distended abdomen, tender in mid abdomen and left lower quadrant

Laboratory test:

WBC and lactate within normal limits

Question 1:

What diagnostic imaging test should be considered at this point?

A) MRI abdomen/pelvis
B) Abdominal plain film
C) Ultrasound abdomen
D) No imaging required: conservative care     indicated at this time


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